Provider Demographics
NPI:1841623618
Name:MOSALLAI, ANAHITA (MA)
Entity type:Individual
Prefix:MS
First Name:ANAHITA
Middle Name:
Last Name:MOSALLAI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ANA
Other - Middle Name:
Other - Last Name:NOJUMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:880 PAKELE PL
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-8503
Mailing Address - Country:US
Mailing Address - Phone:949-433-3355
Mailing Address - Fax:
Practice Address - Street 1:880 PAKELE PL
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-8503
Practice Address - Country:US
Practice Address - Phone:949-433-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF62285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist